Fetal outcome of HIV positive pregnant women taking highly active antiretroviral therapy at Yaoundé Central Hospital: a cross sectional analytic study

Background: HIV infection in pregnant women is delicate both for the mother and her child. With the adoption of option B+ treatment plan by Cameroon’s ministry of public health, there has been a marked decrease in the vertical transmission of HIV from mothers to their babies. There is a dearth of evidence in sub-Saharan Africa, especially in Cameroon, on the effects of highly active antiretroviral therapy (HAART) on pregnancy and foetal outcomes with respect to the time from onset of treatment. We therefore carried out this study to determine the foetal outcome of women on HAART. We hypothesized that the foetal outcome is poorer for pregnant women starting HAART during pregnancy compared to those starting HAART prior to conception.Methods: We carried out an analytic cross-sectional study which spanned from the 1st February to 30th April 2017 at the Yaoundé Central Maternity. We included consenting hospitalised HIV infected women who just terminated a pregnancy (abortion or delivery), and who started HAART at least four weeks before termination of pregnancy. Data was analysed using EPI info 7.2.1.0. SPSS version 20.0. Odds ratio (OR) was used to assess the degree of association that could exist between qualitative variables. The threshold of statistical significance was set at a p-value of 0.05.Results: A total of 121 participants were recruited in the present study. The mean age of the participants was 31.3±5.3 years for those who started HAART before pregnancy and 29.4±5.5 years for those who started during pregnancy (p=0.07). The viral loads means for those who started taking HAART before pregnancy 34.6±21.5 cells/mm3 and those who started during pregnancy 60±14 cells/mm3 (p = 0.01). Overall there were not any significant adverse fetal outcomes caused by taking HAART before or during pregnancy (p >0.05).Conclusions: Despite the fact that the viral load was more elevated in women starting HAART prior pregnancy compared to those started during pregnancy, there was no significant adverse foetal outcome related to time of initiation of HAART treatment by pregnant HIV positive in Yaoundé central Maternity. We suggest that the implementing of the test and treat strategy will have a positive impact on the vertical transmission of HIV

Prevalence and associated factors of HIV infection among pregnant women attending antenatal care at the Yaoundé central hospital

Background: HIV infection affects millions of people worldwide, especially in sub-Saharan Africa. Transmission occurs by several means including the transmission from mother to child. The objective of this study was to determine the prevalence and factors associated with HIV infection in women attending antenatal care at the Yaoundé Central Hospital.Methods: We conducted an analytical cross-sectional study at the Obstetrics and Gynecologic Unit of the Yaoundé Central Hospital from 6th October 2015 to 30th June 2016. The sampling was consecutive. We included 360 pregnant women. Testing was done by a sensitive test and a specific test if the first was positive. Data analysis was done through Excel 2007 software EpiData Analysis Version 3.2 and STATA version 12.0 (Texas USA 2001). Statistical significance was accepted for a value of P <0.05.Results: The average age of our population was 27.99±5.63 years, ranging from 15 and 47 years. HIV prevalence in this population was 13.1% (47/360). Factors associated with HIV were the primary level of study (OR=7.97; 95% CI=2.23 to 28.49, P=0.001) and multiple sexual partners (OR=4.82; CI 95%=2.24 to 10.38, P=0.002).Conclusions: HIV prevalence in pregnant women at the Maternity of HCY is 13.1%. The low level of education and multiple sexual partners were significantly associated with HIV infection. We suggest the education of the girls who is a key factor in the empowerment of women

High birth weight in a suburban hospital in Cameroon:An analysis of the clinical cut-off, prevalence, predictors and adverse outcomes

BACKGROUND AND AIMS: High birth weight (HBW) increases the risk of maternal and fetal morbidity and mortality. Its prevalence and adverse outcomes may be reduced if risk factors are identified and managed during pregnancy. The cut-off value for HBW remains debatable. The objectives of this study were to identify the optimal cut-off value and determine the prevalence, predictors and adverse outcomes of HBW in a suburban area of Cameroon. DESIGN: A 6-year retrospective register analysis and a 3-month prospective phase. SETTING: A secondary care level (regional) hospital in the city of Buea (southwest region of Cameroon). PARTICIPANTS: Women who delivered in this hospital over a 6-year period (retrospective phase) and consenting pregnant mothers and their infants (singletons, born at >28 weeks gestation) (prospective phase). OUTCOME MEASURES: 90th centile of birth weights; prevalence of HBW defined as birth weight above the 90th centile; sociodemographic, maternal and obstetrical factors associated with HBW; maternal and neonatal adverse outcomes of HBW. RESULTS: Of the 4941 newborns reviewed in registers, the 90th centile of birth weights was 3850 g. Using this new cut-off, we obtained a prevalence of 14.0% for HBW in the 200 newborns included in the prospective phase. This was significantly higher than the prevalence (9.5%) yielded when the traditional cut-off of 4000 g was used (p=0.003). None of the factors assessed was independently associated with HBW. Newborns with HBW were more likely to have shoulder dystocia (p<0.01), and their mothers more likely to suffer from prolonged labour (p=0.01) and postpartum haemorrhage (p<0.01). CONCLUSIONS: The results of this study suggest that the cut-off for HBW in this population should be 3850 g. Thus, 3 of every 10 babies born with HBW in this hospital are likely not receiving optimal postnatal care because 4000 g is currently used to qualify for additional support

Hématome vulvaire massif du post-partum: à propos d’un cas à l’Hôpital Central de Yaoundé (Cameroun)

Les hématomes puerpéraux sont une cause rare d’hémorragie du post-partum. Leur prise en charge adéquate nécessite une compétence et un plateau technique particulier. A notre connaissance, aucun cas n’a été publié au Cameroun. Nous rapportons le cas d’une femme de 37 ans, G3P2013, référée d’un dispensaire vers la  maternité de l’hôpital Central de Yaoundé, en état de choc hémorragique survenu une heure après un  accouchement facilité par des manoeuvres digitales de dilatation vaginale. Elle a été prise en charge  chirurgicalement pour un hématome vulvaire expansif. Ce cas nous permet d’attirer l’attention des praticiens  sur la gravité et la singularité de cette pathologie hautement morbide qui pourrait être due à des manoeuvres de dilatation digitale du vagin pendant le travail.Key words: Hématome vulvaire, hématome puerpéral, hémorragie du post-partum, thrombus péri-génital, Camerou

Risk factors of intrauterine fetal death: a case control study at the maternity of Yaoundé Central Hospital

Background: Intrauterine fetal death (IUFD) is the death before the beginning of the work of the fetus from the 28th week of pregnancy or a fetus of weight greater than or equal to 1000g. It occurs in 98% in poor countries, particularly in sub-Saharan Africa. The aim of this study was to identify the risk factors for IUFD in low-income countries.Methods: All the women with preeclampsia from 30 weeks onwards were enrolled in the study. The umblical artery (UA) Systolic-diastolic (S/D) ratio >2 standard deviation (SD) or UA-pulsatility index (PI) and UA-resistive index (RI) >2 SD were taken as abnormal. The middle cerebral artery (MCA) was visualised and cerebroumblical PI ratio calculated. MCA-RI<2SD was taken as abnormal.Results: Independent risk factors for IUFD are age over 30 years (ORa = 2.1, P = 0.052), (ORa = 2.4497, p = 0.01), household occupation (ORa = 2.0097, p = 0.0282), hypertension disorders (ORa = 2.11, p = 0.0176), antepartal haemorrhage (ORa = 3.9635, p = 0.000), multiparity (ORa = 13.3089, p = 0.0056).Conclusions: The main risk factors for IUFD identified in our study are maternal age greater than 30 years, hypertension, antepartal haemorrhage, multiparity, and the household profession. Any pregnant woman who has one of these factors should be follow-up closely during pregnancy with a weekly assessment of fetal well-being by the 28th week

Torsion d’annexe en cours de grossesse: à propos d’un cas à l’Hôpital Central de Yaoundé, Cameroun

Les kystes ovariens sont dans la majorité des cas asymptomatiques et peuvent être de découverte fortuite lors d'une échographie. Ils ne deviennent symptomatiques que lorsque survient une complication. Nous  présentons un cas de torsion d'annexe gauche diagnostiqué à 8 semaines et 4 jours de grossesse. Nous avons réalisé une annexectomie Suivie de l'administration de progestérone retard à la dose 500 mg par jour. L'évolution a été marquée par la survenue d'un avortement au cinquième jour post opératoire. L'analyse  anatomopathologique de la masse chirurgicale a conclu à une apoplexie ovarienne. L'ablation chirurgicale du corps jaune au premier trimestre de la grossesse pose le problème du maintien de celle - ci et devrait être présente à l'esprit des praticiens avant toute chirurgie pelvienne pendant cette période.Key words: Kyste ovarien, grossesse, torsion, annexe, avortemen

Dysmenorrhea among students in Yaounde, Cameroon: associated factors and socio-cultural aspects

Background: Dysmenorrhea is very common disorder. It affects the quality of life and is the main cause of school absenteeism’s among teenagers. The goal of this study was to determine socio-cultural aspects of dysmenorrhea among students in Yaounde and factors associated with it.Methods: Authors carried out a cross sectional analytic study in 2 secondary schools and a higher institute in Yaounde, from December 1, 2017 to June 30, 2018 (7 months). Authors included all students aged at least 15, in form 5 and above. In the higher institute, sampling was consecutive, while it was stratified into 2 clusters in the secondary schools.  Odds ratios were determined to assess association between variables and P-value ˂0.05 was considered significant.Results: Of the 1059 participants, 800 had dysmenorrhea (prevalence: 75.5%). Mean age was 18.88±3.62 years (range: 15-45 years). Family history of dysmenorrhea (OR: 4.20 (95% CI: 3.02-5.83)) and stress ((OR: 2.16 (95% CI: 1.55 - 3.02)) were significantly associated with dysmenorrhea. A duration of menses ≤3 days was protective ((OR: 0.31 (95% CI: 0.12-0.82)). Dysmenorrhea remains a taboo for 23.6% of participants.Conclusions: Family history of dysmenorrhea and stress are risk factors for dysmenorrhea which remains a taboo for almost a fourth of affected women. Authors recommend educating women about dysmenorrhea and control psycho-social stress

Utilisation de l’echographie doppler couleur dans la localisation de l’insertion du cordon ombilical et le devenir materno-foetal à la maternité de l’hôpital central de Yaoundé : une étude descriptive et analytique

Introduction: L'échographie doppler couleur permet d'étudier l'insertion du cordon ombilical sur le placenta. Les études américaines et asiatiques montrent que les insertions anormales telles les  insertions vélamenteuses et marginales sont associées à une élévation de la morbidité et de la mortalité périnatales. En Afrique et plus particulièrement au Cameroun, aucune étude n'a été publiée sur le sujet. D'où notre motivation à mener ce travail.Méthodes: Il s'agissait d'une étude descriptive et analytique qui s'est déroulée sur une période deux ans (2011-2012) à la maternité principale de l'Hôpital Central de Yaoundé. Cette étude a inclus 66 patientes qui ont subi chacune une échographie doppler couleur entre la 18ième et 30ième semaine de gestation, précisant le type d'insertion du cordon ombilical sur le placenta. A l'accouchement, un examen  macroscopique du placenta a été réalisé afin de comparer le type d'insertion et réaliser les tests statistiques. Résultats: Des 66 grossesses étudiées, nous avons eu un pourcentage de visualisation du type d'insertion de 100%. Toutes les insertions étaient normales à l'échographie soit 20 centrales et 46 latérales. A l'examen macroscopique du placenta, nous avons obtenu 19 (28,8%) insertions centrales, 47(71,2%) insertions latérales ; aucune insertion anormale n'ayant été objectivée. Les tests statistiques nous permettent d'avoir une sensibilité de 95%, une spécificité de  97,8%, une exactitude de 98%, une valeur prédictive positive de 95% et une valeur prédictive négative de 97,8%. Pour ces insertions, nous n'avons pas retrouvé d'association entre le mode d'accouchement, le poids de naissance, et le Score d'apgar avec le type d'insertion du cordon ombilical. Conclusion: Nous avons conclu que l'échographie doppler couleur a une haute sensibilité et spécificité dans la détermination de l'insertion du cordon ombilical sur le placenta. Il n'y a pas d'association entre le type d'insertion et le devenir maternofoetal. Key words: Echographie doppler couleur, sensibilité, spécificité, insertion du cordon ombilica

Maternal mortality in Cameroon: a university teaching hospital report

More than 550,000 women die yearly from pregnancy-related causes. Fifty percent (50%) of the world estimate of maternal deaths occur in sub-Saharan Africa alone. There is insufficient information on the risk factors of maternal mortality in Cameroon. This study aimed at establishing causes and risk factors of maternal mortality. This was a case-control study from 1st January, 2006 to 31st December, 2010 after National Ethical Committee Approval. Cases were maternal deaths; controls were women who delivered normally. Maternal deaths were obtained from the delivery room registers and in-patient registers. Controls for each case were two normal deliveries following identified maternal deaths on the same day. Variables considered were socio-demographic and reproductive health characteristics. Epi Info 3.5.1 was used for analysis. The mean MMR was 287.5/100,000 live births. Causes of deaths were: postpartum hemorrhage (229.2%), unsafe abortion (25%), ectopic pregnancy (12.5%), hypertension in pregnancy (8.3%), malaria (8.3%), anemia (8.3%), heart disease (4.2%), and pneumonia (4.2%), and placenta praevia (4.2%).Ages ranged from 18 to 41 years, with a mean of 27.7 ± 5.14 years. Lack of antenatal care was a risk factor for maternal death (OR=78.33; CI: (8.66- 1802.51)). The mean MMR from 2006 to 2010 was 287.5/100,000 live births. Most of the causes of maternal deaths were preventable. Lack of antenatal care was a risk factor for maternal mortality. Key words: Maternal mortality, causes, risk factors, Cameroon.Keywords: Pregnancy, maternal death, Yaoundé, Cameroon, causes, risk factor

Facteurs prédictifs de l’échec du Traitement Préventif Intermittent du paludisme à la sulfadoxine – pyriméthamine (TPIp-SP) dans une population de femmes enceintes à Yaoundé

Introduction: Le traitement préventif intermittent à la sulfadoxine-pyriméthamine (TPIp-SP) est recommandé pour prévenir le paludisme pendant la grossesse. Nous avons recherché les facteurs associés à l'échec de cette stratégie. Méthodes: Nous avons mené une étude cas - témoins dans deux formations sanitaires de Yaoundé, du 1er Mai 2014 au 30 Avril 2015. Les femmes enceintes sous TPIp-SP hospitalisées pour paludisme ayant un Test de Diagnostic Rapide (TDR) positif (cas) étaient comparées aux femmes enceintes sous TPIp-SP ayant un TDR négatif (témoins). Les logiciels Epi info 7 et SPSS 18.0 ont été utilisés avec P&lt;0,05 comme seuil de significativité. Résultats: Nous avons recruté 234 sujets, 109 cas (46,6%) et 125 témoins (53,4%). Les facteurs associés retrouvés étaient : la primiparité (P=0,03 ; OR=1,15; IC= 0,32 - 4,10), la non utilisation de la MILDA (P=0,006 ; OR= 2,31 ; IC= 1,26 - 4,25), un antécédent d'hospitalisation pour paludisme (P=0,007 ; OR= 2,19 ; IC= 1,23 - 3,89), le début de la TPIp-SP après la 28ème semaine de grossesse (P=0,001, OR= 3,55; IC= 1,7 - 7,61). Après régression logistique, la primiparité (P=0,024 ; OR=2,01 ; IC=1,1-3,7) et un antécédent d'hospitalisation pour paludisme (P=0,001 ; OR=2,83 ; IC=1,50-5,4) restaient associés à l'échec du TPIp-SP. Conclusion: Un antécédent d'hospitalisation pour accès palustre et la primiparité sont des facteurs prédictifs indépendants de l'échec de la TPIp-SP.Pan African Medical Journal 2016; 2